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Objective:To investigate the application value of stereotactic digital naviga-tion system assisted three-dimensional (3D) laparoscopic total mesorectal excision (TME) for rectal cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of a healthy volunteer recruited by the Second Affiliated Hospital of Army Medical University and 3 patients who underwent stereotactic digital navigation system assisted 3D laparoscopic TME for rectal cancer in the Second Affiliated Hospital of Army Medical University from May to September 2019 were collected. The healthy volunteer was male, aged 25 years. Of the 3 rectal cancer patients, there were 2 males and 1 female, with the age of 48 years, 63 years and 67 years, respectively. Ten special patches were placed at the anterior superior iliac spine, pubic tubercle and pubic symphysis of the volunteer's bilateral inguen as skin reference points in intraoperative localization and system registration. On the day of operation, patients were placed 10 special patches as skin reference points according to the test results of the volunteer and were completed the enhanced scan of totally abdominal computed tomography examination. Seven fixed anatomical markers in the abdominal cavity of the patients, including abdominal aortic bifurcation, sacrum scapula, bilateral anterior superior iliac spine, bilateral intersection of ureter and iliac artery and median point of peritoneal reflection, were selected for verifying the accuracy of the correspondence between the instrument tip and the system image. Patients underwent 3D laparoscopic TME for rectal cancer assisted by stereotactic digital navigation system. Observation indicators: (1) test results; (2) surgical situations; (3) accuracy of stereotactic digital navigation system. Measurement data with normal distribution were represented as Mean± SD. Results:(1) Test results. The 10 skin reference points of the volunteer were successfully registered in the stereotactic digital navigation system, with the registration error of 2.8 mm. (2) Surgical situations. All the 3 patients underwent stereo-tactic digital navigation system assisted 3D laparoscopic TME for rectal cancer successfully. The operation time of the 3 patients were 193 minutes, 175 minutes, 210 minutes, respectively, in which the set time of the stereotactic digital navigation system were 34 minutes, 25 minutes, 45 minutes, respectively. The volume of intraoperative blood loss of the 3 patients were 60 mL, 30 mL, 80 mL, respectively. Results of postoperative pathological examination showed 3 patients with adenocar-cinoma, including 1 case with mucinous adenocarcinoma. The tumor diameter and the numbers of lymph nodes dissected of the 3 patients were 2.3 cm, 1.5 cm, 4.0 cm and 12, 12, 13, respectively. No patient had lymph node metastasis. The 3 patients in preoperative clinical TNM stage cT3bN0M0, stage cT4aN1M0, stage cT3bN1M0 were in yield pathological TNM stage ypT1N0M0, stage ypT4aN0M0, stage ypT2N0M0 after neoaduvant chemotherapy, respectively. No patient had complication, and the duration of postoperative hospital of the 3 patients was 7 days, 6 days, 7 days, respectively. (3) Accuracy of stereotactic digital navigation system. The registration errors of the skin reference points were 2.8 mm, 2.6 mm, 2.9 mm and the accuracy errors of the abdominal cavity reference points were (2.5±0.4)mm, (2.3±0.7)mm, (2.6±0.6)mm for the 3 patients.Conclusion:The stereotactic digital navigation system assisted 3D laparoscopic TME for rectal cancer is safe and feasible.
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Objective:To investigate the changes in total radioactivity in patient body with differentiated thyroid carcinoma (DTC) after 131I treatment and the factors influencing its metabolism. Methods:The clinical data from 218 patients after DTC treatment in the Department of Nuclear Medicine, the Second Affiliated Hospital of Air Force Medical University from September 2021 to April 2022 were retrospectively analyzed. Based on administrated 131I dose, 171 patients were divided into low-dose group (≤ 3.7 GBq) and 47 into high-dose group (>3.7 GBq) . A whole body dynamic radiation monitoring system was used to measure the in vivo residual activity of 131I 24, 48 and 72 h after 131I administration and to explore their influencing factors. Results:24, 48 and 72 h after adimination of 131I, the residual activity of 131I in the low-dose group patients was significantly lower than in the high-dose group patients ( t= -7.46, -3.31, -2.01, P<0.05) . The discharge compliance rate at 24 and 48 h in the low-dose group was significantly higher than that in the high-dose group (21.0% vs. 4.3%, 98.2% vs. 89.4%, χ2 = 7.23, 5.91, P<0.05) , and all patients could meet the discharge criteria at 72 h. Univariate analysis showed that the residual 131I activity at 24 and 48 h was dependent on age, body mass index (BMI) , basal metabolism rate (BMR) and thyroid stimulating hormone (TSH) . As have been shown by multiple linear regression analysis, in the low-dose group, the older age, the higher BMR and the higher TSH level at 24 h tended to the higher 131I residual activity in the body. At 48 h, the higher BMI and the higher TSH level lead to the higher 131I residual activity in patient body. Meanwhile, in the high-dose group, the higher age and BMR at 24 h, tended to the higher in vivo131I residual activity. The influencing factors were analyzed in terms that 131I residual activity reaching 400 MBq in patient body at 24 and 36 h. The result showed that at 24 h the lower TSH level leaded to the lower 131I residual activity in patient body. At 36 h, the younger age, the lower TSH level, and the smaller 131I treatment dose tended to the lower in vivo131I residual activity. Conclusions:Age, BMI, BMR and TSH levels are the influencing factors for the change in total activity in patient body after 131I treatment of DTC. Radiation dose assessment based on the above indicators can provide a reference for adjusting the length of hospitalization time.
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Objective:To study the functional connectivity (FC) and metabolic effective connectivity (MEC) patterns of the default mode network (DMN) in healthy male adults based on a novel hybrid PET/MR system.Methods:Fifteen healthy male adults with median age of 29 years were recruited locally in Xi′an from January to May 2019. All subjects went through PET/MR scan to get the whole brain 18F-fluorodeoxyglucose (FDG) PET, resting-state functional MRI (fMRI) and magnetization prepared rapid gradient echo (MPRAGE) T 1 weighted imaging data. CONN18b and statistical parametric mapping (SPM) 12 softwares were used to analyze data. The voxel-wise FC and FDG metabolic data were extracted within 4 sub-networks of DMN, which included medial prefrontal cortex (MPFC), posterior cingulate cortex (PCC) and bilateral lateral parietal (LP). The FC and MEC between 4 sub-networks were calculated based on merged resting-state fMRI and metabolic data, and analyzed by one-sample t test separately, with Bonferroni correction. Results:FC pathways were all significant within 4 sub-networks of DMN ( t values: 6.00-7.71, all P<0.008, Bonferroni corrected). Meanwhile, there were significant bi-directional MEC between MPFC and PCC(MPFC to PCC: t=10.03; PCC to MPFC: t=3.73, both P<0.004, Bonferroni corrected), as well as between bilateral LP (LP_L to LP_R: t=5.28; LP_R to LP_L: t=4.76, both P<0.004, Bonferroni corrected). There were significant uni-directional MEC from both MPFC and PCC to bilateral LP ( t values: 3.44-6.93, all P<0.004, Bonferroni corrected). Conclusions:Special FC and MEC patterns exist within DMN. The closely interrelated MPFC and PCC play more important roles in DMN, and they may mediate LP jointly. The novel integrated PET/MR system will bring new perspective on the organization of brain networks, which may deepen the comprehensive understanding of DMN.
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Objective To investigate the relationship between the epidemiology of chronic rhinitis and atmospheric environmental factors in Wuhan. Methods A total of 3 371 patients with chronic rhinitis in Wuhan seventh hospital from January 2017 to January 2020 were enrolled. The incidence of chronic rhinitis in different years and seasons was compared. Then the influence of atmospheric environmental factors such as air pollution index (API), fine particulate matter (PM2.5), inhalable particulate matter (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), diurnal patterns of relative humidity, wind speed, air temperature, air pressure wind speed and temperature range on occurrence of chronic rhinitis was analyzed. Results The incidence of chronic rhinitis in Wuhan showed an annual decreasing trend from 2017 to 2020, so the incidence rate was the highest in 2017 (38.83%, 1309/3371) and was the lowest in 2020 (28.98%, 977/3371). In terms of different seasons, the incidence rate was the highest in winter (33.67%, 1135/3371), and was the lowest in summer (16.11%, 543/3371). The main factors affecting the incidence of chronic rhinitis were API, PM2.5, and PM10 in spring, which were NO2, SO2, and daily average relative humidity in summer, those were API, PM2.5, PM10, NO2, and SO2 in autumn, and were API, PM2.5, PM10, NO2, SO2, and daily range of air temperature in winter. The lag response of patients with chronic rhinitis to atmospheric environmental factors was 2-5 days in spring, 1-6 days in summer, 0-5 days in autumn and 3-6 days in winter. Patients with chronic rhinitis have the fastest response to API and PM2.5 in spring, the fastest response to API in summer, and the fastest response to API and PM2.5 in autumn, respectively. Conclusion The incidence of chronic rhinitis in Wuhan is decreasing year by year, and the incidence is related to environmental and meteorological factors, and the disease onset has the characteristics of lag due to seasonal factors.
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<p><b>OBJECTIVE</b>To explore the feasibility, safety, and preliminary technical experience of single incision plus one port laparoscopic total gastrectomy combined with π-shaped esophagojejunal anastomosis (SILT-π) in the surgical treatment of gastric cancer.</p><p><b>METHODS</b>Clinical data of 5 gastric cancer patients undergoing SILT-π operation at the Department of General Surgery, The Second Affiliated Hospital of the Army Medical University from August to October 2017 were retrospectively analyzed. A 2.5-3.0 cm incision around the umbilicus was made for placing the gloveport as the passage for the lens, and the instruments of the surgeon and the assistant. Another operative port was placed in the left upper quadrant with a 12-mm Trocar for the passage of the energy device, the endoscopic cutting closure, as well as the postoperative drainage tube. A D2 lymph node (LNs) dissection was regularly conducted. After the abdominal esophagus was routinely mobilized, a side-to-side esophagus-jejunum anastomosis was made through a gastric pre-pulling esophagojejunal π-shaped anastomosis. The transection was then performed with a ligation on the cardia (or esophagus above the upper margin of the tumor) using a sterilized hemp rope in order to better expose the abdominal esophagus. Throughout the course of reconstruction, the ligature rope was held by the assistant to hold down the esophagus to allow easier esophagojejunal anastomosis. A hole was then made on the posterior wall of the esophagus, between 2 cm and 3 cm above the ligature rope, and another hole was made at the anti-mesenteric border of the jejunum 40 cm distal to the Treitz ligament. A side-to-side esophagojejunal π-shaped anastomosis was performed through two holes. An entry hole was formed after the anastomosis. After checking the anastomosis, this entry hole was closed through an intestinal mesenteric hole pre-made on its opposite side. The resected esophagus and stomach, together with the afferent loop jejunum, were simultaneously transected above the level of the entry hole by a stapler from the Trocar of the left upper abdominal quadrant. After the gloveport was closed, a side-to-side jejunojejunostomy anastomosis applied with another two staples was performed between the afferent loop stump and the roux limb 30 cm below the esophagojejunal anastomosis.</p><p><b>RESULTS</b>These five patients were all male, and aged (56.8±8.2) years with preoperative clinical stage cT2-4N0-2M0. All the 5 patients underwent SILT-π operation successfully. The average length of surgical incision was (2.9±0.2) cm. The average operation time was (396.0±36.1) minutes. The intraoperative blood loss was (140.0±66.7) ml. Postoperative pathology showed proximal and distal margins were (2.6±1.1) cm and (8.7±2.5) cm apart respectively, and the average number of retrieved lymph node was 25.8±7.2. Perioperative management was based on enhanced recovery following surgical (ERAS) principles. The average time to the first flatus was (2.6±0.5) days, and the average time to defecation was (3.6±0.5) days. The pain score on postoperative day 1 was 1-2, and the average postoperative hospital stay was (7.0±0.7) days. No perioperative complications occurred.</p><p><b>CONCLUSIONS</b>SILT-π procedure is safe and feasible for patients with gastric cancer, and has positive short-term outcomes, satisfactory cosmetic abdominal incision, light postoperative abdominal pain and rapid postoperative recovery. Preliminary observations show that SILT-π procedure has good potential for clinical application in future.</p>
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Aged , Humans , Male , Middle Aged , Anastomosis, Surgical , Esophagus , General Surgery , Gastrectomy , Methods , Jejunum , General Surgery , Laparoscopy , Retrospective Studies , Stomach Neoplasms , General SurgeryABSTRACT
Objective To explore the neural function analysis based on PET/CT imaging for the MRI negative localization in patients with refractory epilepsy.Methods 85 cases of drug refractory epilepsy patients (male 47,female 38,M/F:1.2 ︰ 1;age range from 6-35 years old),receiving head PET/CT conventional imaging in the interphase,compared to the normal PET cerebral metabolic databases.Surgery was carried out on the patients who with unilateral lobe of the brain,the efficacy was evaluated according to the Eagle standard.Results Epilepsy in unilateral was 63.5%(54/85 ),bilateral was 28.2%(24/85 )and unclear was 8.3%(7/85 ).6 months,12 months,18 months and 24 months later after surgery in patients who with unilateral lobe,the efficacy reaching the Eagle class Ⅰ and class Ⅱ standards was 61.1% (33/54),61.1% (33/54),61.1% (33/54),59.1% (29/49 ),respectively.Conclusion PET/CT neural function analysis could find epileptogenic zone which was negative in MRI imaging in patients with refractory epilepsy, is one of the important methods of preoperative localization.
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Objective:To investigate the relationship between VitD 3 concentration and glucose and insulin levels of OGTT in patients with CKD 3-5 stages.Methods: We included the patients with CKD 3 and 4 and 5 stages who fulfill the including standard.All patients were recorded the concentrations of [1,25 (OH):D3]concentration of glucose and insulin at fasting ,postprandial 1 h,2 h during OGTT and concentration of glycosylated hemoglobin level ,C peptide concentration.We performed the correlation analysis about [1,25 (OH):D3],glucose and insulin.Results: We totally included 91 patients with 3-5 stages CKD into our study.The D3 concentration of stage 3 were 160.9-261.3 mmol/L[(218.38±8.67)mmol/L] of stage 3,75.2-166.3 mmol/L[(117.01±4.72) mmol/L] of stage 4 and 11.8-96.5 mmol/L[(41.91±12.83)mmol/L] of stage 5 (P<0.05).The average concentrations of serum glucose at fasting,1 h after the meal and 2 h after the meal was(4.74±0.21)mmol/L,(8.31±0.43)mmol/L and(7.36±0.32)mmol/L in 3 stage and (4.92±0.25) mmol/L,(9.14±0.15) mmol/L and (9.14±0.39)mmol/L at 4 stage and (4.81±0.13)mmol/L, (10.72±0.41)mmol/L and (10.72±0.49)mmol/L at 5 stage (P<0.05).The average concentrations of insulin during OGTT at fasting,1 h after the meal and 2 h after the meal was (6.58±0.32) μU/L,(57.78±5.63)U/L and (42.77±8.45)U/L in 3 stage (6.03±0.53)U/L,(55.69±7.35)U/L and (62.52±5.39)U/L in 4 stage and (6.12±0.65)U/L,(62.82±9.73)U/L and (77.34± 8.62)U/L in 5 stage (P<0.05).Correlation analysis shows that the concentration of 1,25 (OH):D3 of different stages of patients with CKD and vitamin D 3 concentration and glucose tolerance test was found to be inversely associated with the insulin levels ( P<0.05 ) . Conclusion:There are obvious differences of concentration of vitamin D 3 between patients with 3-5 stages of chronic kidney disease (CKD).There also showed a negative correlation relationships between glucose and insulin levels ,and vitamin D3 concentration and glucose and insulin levels at OGTT of patients with 3-5 stages CKD.
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OBJECTIVE@#To assess the effect of desloratadine on quality of life (QOL) in patients with seasonal allergic rhinitis.@*METHOD@#A randomized, double-blind, placebo-controlled study was designed on fifty patients with seasonal allergic rhinitis. The patients were randomly divided into three groups: A group: taking desloratadine by mouth and taking spraying of normal sodium; B group: placebo group, taking placebo by mouth and taking spraying of normal sodium; C group: taking desloratadine by mouth and taking spraying of Nasonex. Rhinitis quality of life (RQOL) questionnaire was used to evaluate QOL of patients with seasonal allergic rhinitis. The method of taking tabella was one tablet, one time a day; the method of taking spraying was one spray each nostril, once a day. The investigation lasted for two weeks. The RQOL questionnaire was administered at the start of the treatment and after one and two weeks of treatment by the telephone follow-up investigation.@*RESULT@#After 1 and 2 weeks of treatment, symptoms scores were significantly decreased in the A group and C group compared with the placebo group (P < 0.05). After 1 and 2 weeks of treatment by the methods of A and C, the QOL of patients with seasonal allergic rhinitis was significantly improved compared with placebo group (P < 0.05). There was no QOL improvement in the placebo group.@*CONCLUSION@#Desloratadine could decrease symptom scores and improve QOL in patients with seasonal allergic rhinitis. The RQOL questionnaire could help doctor to effectively evaluate QOL in patients with seasonal allergic rhinitis, because of its integrity and convenience.
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Double-Blind Method , Histamine H1 Antagonists, Non-Sedating , Therapeutic Uses , Loratadine , Therapeutic Uses , Quality of Life , Rhinitis, Allergic, Seasonal , Drug Therapy , Treatment OutcomeABSTRACT
Objective To explore the concentration of required residual available chlorine dioxide(ClO 2 )and optimun contact time for ClO 2 disinfection in order to ensure the microbiological indexes of waste water of hospital disinfected by ClO 2 qualified.Meth ods The waste water samples collected from hospital,to which were aritificially added with predetermined con-centrations of bacteria,were disinfected by various concentrations of ClO 2 (2?4?6?8?10?12mg /L)with various contact time (5?10?30?60?90min).After disinfection,the concentration of residual ClO 2 and the contents of microorganism in waste water samples were determined.Re sults After30-min disinfection by10.0mg /L ClO 2 ,the waste water sample originally containing1.52?10 2 /L E.coli showed a bactericidal rate of99.99%and a concentration of residual ClO 2 at2.5mg /L.After10-min disin-fection by10.0mg /L ClO 2 ,the waste water samples originally containing1.12?10 10 /L Salmonella showed a bactericidal rate of100%and a concentration of residual ClO 2 at2mg /L.After5-min disinfection by10.0mg /L ClO 2 ,the waste water samples o-riginally containing M.tu berculosis at concentration of++++showed a negative result and a concentration of residual ClO 2 at3.5mg/L.Conclusion After the primary treatment,ClO 2 disinfection with contact time of30minutes and a residual concentration of ClO 2 at2.5mg /L could ensure the germicidal effect for E.coli,Salmonella and M.tu berculosis in waste water of hospital qualified.